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Objective: Prevention of catheter-related bloodstream infection is a basic objective to optimize patient safety in the ICU. Building on the early success of a patient safety unit-based comprehensive intervention (the Keystone ICU project in Michigan), the Bacteremia Zero project aimed to assess its effectiveness after contextual adaptation at large-scale implementation in Spanish ICUs.

Design: Prospective time series.

Setting: A total of 192 ICUs throughout Spain.

Patients: All patients admitted to the participating ICUs during the study period (baseline April 1 to June 30, 2008; intervention period from January 1, 2009, to June 30, 2010).

Intervention: Engagement, education, execution, and evaluation were key program features. Main components of the intervention included a bundle of evidence-based clinical practices during insertion and maintenance of catheters and a unit-based safety program (including patient safety training and identification and analysis of errors through patient safety rounds) to improve the safety culture.

Measurements and Main Results: The number of catheter-related bloodstream infections was expressed as median and interquartile range. Poisson distribution was used to calculate incidence rates and risk estimates. The participating ICUs accounted for 68% of all ICUs in Spain. Catheter-related bloodstream infection was reduced after 16–18 months of participation (median 3.07 vs 1.12 episodes per 1,000 catheter-days, p < 0.001). The adjusted incidence rate of bacteremia showed a 50% risk reduction (95% CI, 0.39–0.63) at the end of the follow-up period compared with baseline. The reduction was independent of hospital size and type.

Conclusions: Results of the Bacteremia Zero project confirmed that the intervention significantly reduced catheter-related bloodstream infection after large-scale implementation in Spanish ICUs. This study suggests that the intervention can also be effective in different socioeconomic contexts even with decentralized health systems.

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Supported, in part, by the Spanish Ministry of Health, Social Policy and Equality through a contract with SEMICYUC (Number 2008/0273−227−06) and specific contracts with the Health Regions during 2009 and 2010.

Dr. Palomar received grant support from the Vall Hebron Hospital (funding from Conselleria de Salut de Catalunya) and Pfizer, support travel from the Sociedad Española de Medicina Intensiva and Critica y Unidades Coronarias, lectured for Pfizer and 3M, and received support for travel from Novartis. Dr. Álvarez-Lerma received grant support from Conselleria de Salut de Catalunya, Astra Zeneca, Novartis, and Gilead; support for travel from Sociedad Española de Medicina Intensiva and Critica y Unidades Coronarias; consulted for Gilead and Novartis; lectured for Pfizer, Astellas, Novartis, and MSD; received payment for manuscript preparation from Gilead; and received support for travel from Pfizer and Novartis. Dr. Riera consulted for SEMiCyUC (coordination). Dr. Agra is employed by the Spanish Ministry of Health (SMoH), received grant support from the European Commission (budget to the SMoH to participate in European projects where Dr. Agra is the coordinator for Spain), lectured for Escuela Nacional de Sanidad and Universidad Nacional de Educación a Distancia, received support for development of educational presentations from Escuela Nacional de Sanidad, received support for travel from the European Commission, and received other funding from the Spanish Ministry of Health. Dr. Larizgoitia consulted for, received support for travel, and is employed by the World Health Organization and disclosed that her contribution to this study was part of his work as staff member to the World Health Organization (WHO). Dr. Goeschel received grant support from The John Hopkins University (funding from World Health Organization to help support this project); consulted for The University of Lelcester; received grant support from DaVita Corporation, US Agency for Healthcare Research and Quality, and VHA; and lectured for various agencies and healthcare provider organizations. Dr. Pronovost received grant support from AHRQ and the National Institutes of Health, consulted for APIC and Hospitals and Health Care Systems, served as a board member for the Cantel Medical Group, lectured for Leigh Bureau, and received royalties from Penguin Group. The remaining authors have disclosed that they do not have any potential conflicts of interest.